Category Archives: Adult Survivors of Child Abuse

“To a greater or lesser extent, the first ways in which the world has made sense to us continue to underpin our whole subsequent experience and actions.” – R.D. Laing

To a greater or lesser extent, the ways in which the world first presented itself to us—whether it presented us with regular—or irregular—dosages of chaos, upheaval, brutality, harshness, invalidation, abandonment, insensitivity, anti-love, others’ selfishness, lies, deception; or whether it presented us with safety, warmth, tenderness, security, real love, understanding, validation, sensitivity, structure, support, guidance, kindness, and showed itself to be a nurturing and safe and trustworthy place—will continue to underpin the whole of our subsequent experience and actions. And if our past was terrifying, unsafe, if others let us down, did not actually love us, didn’t try to take on and overcome their own issues and neuroses in order to extend themselves to love and nurture us when we were children, if we were surrounded by bad role models instead of good and decent one, then unless—unless—we begin deeply facing our past—the full catastrophe of our past—and how it has affected us and wired us, and begin letting ourselves fully feel and begin processing that original pain and chaos, it will not only haunt us for the rest of our lives, it will likely be what runs us (and makes us run) for the rest of our lives.

In other words, we may think that we’re through with the past, but the past ain’t through with us.

Beyond its obvious initial negative effects, early and severe and frequent child abuse and or neglect interrupts normal child development, conditions negative affect to abuse-related stimuli, and interferes with the usual acquisition of self capacities—perhaps most especially the development of affect regulation skills.

This reduced capacity for affect regulation places the individual at risk for being more easily overwhelmed by emotional distress associated with memories of the abuse/trauma, thereby motivating the use of dissociation and other methods of avoidance in adulthood.

In this way, impaired self capacities lead to reliance on avoidance strategies, which, in turn, further preclude the development of self capacities.

This negative cycle is exacerbated by the concomitant need of the traumatized individual to process conditioned emotional responses and distorted cognitive schema by repetitively re-experiencing cognitive-emotional memories of the original traumatic events that are triggered either by actual memories of the original event or, what is more likely, cognitive-emotional memories elicited by only slightly related current stimuli or situations (conditioned emotional responses caused by distorted or hypersensitive cognitive schema)—a process that further overwhelms the person’s limited self-capacities and produces distress.

If the individual is sufficiently dissociated or otherwise avoidant, the intrusion-desensitization process will not include enough direct exposure to upsetting material to significantly reduce the survivor’s underlying conditioned emotional distress.

As a result, the individual will continue to have flashbacks and other intrusive symptoms indefinitely, and will continue to rely on avoidance responses such as dissociation, tension reduction, or substance abuse to deal with the negative emotions arising from such re-experiencing.

This process may lead the abuse survivor in therapy to present as chronically dissociated, besieged by overwhelming yet unending intrusive symptomatology, and as having “characterologic” difficulties associated with identity, relational, and affect regulation difficulties.

These avoidance strategies are used at several levels: (a) to reduce awareness of (and therefore susceptibility and sensitivity to) potential environmental triggers, (b) to lessen awareness of memories once they are triggered, and (c) to reduce cognitive and emotional activation once CERs to these memories are evoked.

In the absence of such protective mechanisms, the individual is likely to become overwhelmed by anxiety and stress other negative affects on a regular basis—especially when exposed to triggers of traumatic memory in the environment.

As a result, avoidance defenses are viewed as necessary survival responses by many survivors,

Overshooting occurs when interventions or interaction or even therapy provide too much exposure intensity or focus on material or information that requires additional work before it can be safely addressed (i.e. family history diagram).

Interventions that are too fast-paced may overshoot the therapeutic or healing window because they do not allow the client to adequately accommodate and otherwise process previously activated material before adding new stressful stimuli.

When therapy consistently overshoots the window, the survivor must engage in ineffective and counterproductive avoidance maneuvers (i.e. projection, dissociation, suppression, lashing out, splitting, numbing, impulsivity, relocation) in order to keep from being overwhelmed by the therapy process.

Most often, the client will increase his or her level of dissociation during and after the session or will interrupt the focus or pace of therapy through arguments, “not getting” obvious therapeutic points, changing the subject to something less threatening, or missing or being late to appointments.

Although these behaviors may be seen as “resistance” by the therapist, they are often appropriate protective responses to, among other things, therapist process errors given the abused individual’s limited self capacities (especially limited affect regulation skills) and distorted cognitive schema.

Unfortunately, the client’s need for such avoidance strategies can easily impede therapy by decreasing her or his exposure to effective treatment components.

In the worst situation, therapeutic interventions that consistently exceed the window can harm the survivor. This occurs when the process errors are too numerous and severe to be balanced or neutralized by client avoidance, or when the client is so impaired in the self domain or intimidated by the therapist that he or she cannot adequately utilize self-protective defenses.

In such instances, the survivor may become flooded with intrusive stimuli, may “fragment” to the point that his or her thinking is disorganized and incoherent, or may become sufficiently overwhelmed that more extreme dissociative behaviors emerge.

Further, in an attempt to restore a self-trauma equilibrium, she or he may have to engage in avoidance activities such as self-mutilation or substance abuse after an over-stimulating session.

If one considers posttraumatic stress to consist, in part, of intrusive feelings, thoughts, and memories that are triggered by some sort of reminiscent stimulus, often followed by attempts by the affected individual to avoid such triggers or their emotional effects, then a close cousin of PTSD may be borderline personality disorder. In addition to problems with identity and self-other boundaries, those diagnosed as borderline are often characterized as prone to sudden emotional outbursts, self-defeating cognitions, feelings of emptiness and intense dysphoria, and impulsive, tension-reducing behavior that are triggered by perceptions of having been abandoned, rejected, or maltreated by another person (American Psychiatric Association, 1994). The “borderline” person is often viewed as having problems in impulse control, such that he or she is seen as emotionally over-reactive or hypersensitive to perceived losses or maltreatment, responding with angry affect and sudden, dramatic, and ill-considered behavior.

As with PTSD, many severely abused people have a number of “borderline traits” (some fail to meet all the diagnostic criteria for the disorder, meeting less than 5 of the 9 diagnostic criteria, while others, however, do meet more than 5 of the diagnostic criteria).

And, as per PTSD, the self-trauma model holds that a fair portion of what is considered borderline behavior and symptomatology can be seen, instead, as triggered implicit memories, schemas, and feelings associated with early (in this instance relational) traumas (e.g., abuse, abandonment, rejection, or lack of parental responsiveness/attunement) that the individual, in turn, tries to avoid via “dysfunctional” activities such as substance abuse, inappropriate proximity-seeking, or involvement in distracting, tension-reducing behaviors (e.g., dramatic actions, sexual behaviors, impulsive spending, lying, aggression).

In this way, the “impulsive,” “acting-out” behavior of “borderline” individuals parallels the experience of the PTSD individual, except that in “borderline” individuals the triggers for re-experiencing are usually within some sort of relationship, the activated memories are often implicit, preverbal, and imbedded in attachment disturbance, and the reactions to the activated memories are often more relational and seemingly more primitive since they involve the reliving of unprocessed childhood-era events (see Jacobs & Nadel, 1985, re the “infantile” effects of some activated early childhood memories).

A comparative example. A Vietnam veteran with PTSD might have intrusive sensory re-experiences of a combat scenario after being triggered by the sound of an automobile backfire, and, upon experiencing the Vietnam-era fear associated with the combat memory, engage in attempts to find safety.

An individual with borderline personality disorder, after being triggered by a perceived slight in an intimate relationship, on the other hand, might experience sudden, intrusive thoughts and feelings of abandonment and betrayal associated with childhood maltreatment, and re-experience abuse-era desperation and anger associated with that memory. The individual might then engage in dramatic negative tension-reducing or proximity-seeking or distancing behavior in the context of that relationship.

Both are having posttraumatic reactions that involve reliving a previously traumatic event, although the relational components of the latter are often seen, instead, as evidence of a personality disorder.

Thus, beyond its initial negative effects, early and severe child maltreatment interrupts normal child development, conditions negative affect to abuse-related stimuli, and interferes with the usual acquisition of self capacities—perhaps most especially the development of affect regulation skills.

This reduced affect regulation places the individual at risk for being more easily overwhelmed by the normal stresses inherent in daily life and intimate relationships as well as the emotional distress associated with memories of the abuse/trauma, thereby motivating and activating the automatic (unconscious and reactive) use of dissociation and other methods of avoidance in adulthood.

In this way, impaired and limited self capacities lead to reliance (dependence) on avoidance strategies, which, in turn, further preclude the development of self capacities.

This negative cycle is exacerbated by the concomitant need of the traumatized individual to process conditioned emotional responses and distorted cognitions as well as having to repetitively re-experiencing cognitive-emotional memories of the original traumatic event—all of which represent occasions/situations that can further overwhelm the individual’s impaired/limited self-capacities and produce even more stress and distress.

(Abridged and adapted from “Treating adult survivors of severe childhood abuse and neglect: Further development of an integrative model,” by John Briere, Ph.D. http://www.johnbriere.com/STM.pdf)